CDC posted an update on Covid-19 vaccination on October 13, 2023. In brief, the salient points:
They save lives and prevent hospitalizations.
The vaccines work.
The side effects are mild or moderate.
Scientific evidence supports the safety and effectiveness of the vaccines.
They don’t make you magnetic and they don’t have microchips to track your movements. We’re not living in an X-File episode.
Stairmaster joke from Men in Black
I ran across this article (reference below) on the potential benefit of climbing stairs for cardiovascular health. The highlights and abstract are below:
This large cohort of UK adults demonstrated that climbing more than five flights of stairs daily was associated with over a 20% lower risk of ASCVD.
The associations were broadly concordant in populations with varying susceptibilities to ASCVD.
Participants who discontinued stair climbing between the baseline and resurvey exhibited a higher risk of ASCVD in comparison to those who never engaged in stair climbing.
The associations between the intensity of stair climbing and atherosclerotic cardiovascular disease (ASCVD) and how these vary by underlying disease susceptibility are not fully understood. We aim to evaluate the intensity of stair climbing and risk of ASCVD types and whether these vary by the presence of ASCVD risk factors.
This prospective study used data on 458,860 adult participants from the UK Biobank. Information about stair climbing, sociodemographic, and lifestyle factors was collected at baseline and a resurvey 5 years after baseline. ASCVD was defined as coronary artery disease (CAD), ischemic stroke (IS), or acute complications. Associations between flights of stair climbing and ASCVD were examined as hazard ratios (HRs) from Cox proportional hazards models. The modification role of disease susceptibility on such associations was assessed by analyses stratified by levels of genetic risk score (GRS), 10-year risks of ASCVD, and self-reported family history of ASCVD.
During a median of 12.5 years of follow-up, 39,043 ASCVD, 30,718 CAD, and 10,521 IS cases were recorded. Compared with the reference group (reported climbing stairs 0 times/day at baseline), the multivariable-adjusted HRs for ASCVD were 0.97 (95% CI, 0.93–1.01), 0.84 (0.82–0.87), 0.78 (0.75–0.81), 0.77 (0.73–0.80) and 0.81 (0.77–0.85) for stair climbing of 1–5, 6–10, 11–15, 16–20 and ≥21 times/day, respectively. Comparable results were obtained for CAD and IS. When stratified by different disease susceptibility based on the GRS for CAD/IS, 10-year risk, and family history of ASCVD, the protection association of stair climbing was attenuated by increasing levels of disease susceptibility. Furthermore, compared with people who reported no stair climbing (<5 times/d) at two examinations, those who climbed stairs at baseline and then stopped at resurvey experienced a 32% higher risk of ASCVD (HR 1.32, 95% CI:1.06–1.65).
Climbing more than five flights of stairs (approx 50 steps) daily was associated with a lower risk of ASCVD types independent of disease susceptibility. Participants who stopped stair climbing between the baseline and resurvey had a higher risk of ASCVD compared with those who never climbed stairs.”
This interests me because I climbed well over 20 flights of stairs pretty much every day when I was a consultation-liaison psychiatrist. Occasionally, I logged over 40 flights. The hospital had 8 floors and I was often repeatedly hiking up the stairs. I avoided using elevators because they slowed me down too much.
There was a threshold effect of stair climbing in the study, meaning the benefit was lost if you went over a certain number of “floors.” Going over 15 or 20 didn’t gain much for subjects. A flight was 10 stair steps.
I think the idea is that in those who live in homes with the right number of stair steps, you’ve got a no cost, low tech form of cardiovascular exercise. You might exert a little more stress on the carpet.
On the other hand, you could save wear and tear on the carpet (if you’re worried about it) by spending some money on stair stepping exercise equipment. You can buy a Stairmaster model for about $2.000-3,000. There are cheaper stair stepper models, which look a little flimsy and even unstable enough to raise the risk for falls, in my view.
But I would never go back to work just to climb the stairs again.
Reference:
Song Z, Wan L, Wang W, Li Y, Zhao Y, Zhuang Z, Dong X, Xiao W, Huang N, Xu M, Clarke R, Qi L, Huang T, Daily stair climbing, disease susceptibility, and risk of atherosclerotic cardiovascular disease: A prospective cohort study, Atherosclerosis (2023)
The CDC recommendations for Fall-winter immunizations were updated as of September 29, 2023. A few states require a physician’s prescription for the RSV vaccine. Information varies on the web on which states require a prescription for the RSV vaccine. The Iowa Board of Pharmacy website is clear on the matter–you’ll need a prescription.
Most states don’t require a prescription for the RSV vaccine. The CDC recommends having a shared decision-making discussion with your doctor to help you decide about whether the RSV vaccine is right for you. The best thing to do would be to call your doctor, the state board of pharmacy, or your local pharmacy to find out how you should proceed.
Today I got the new Covid-19 vaccine and the flu shot. I scheduled on line late last week and got right in. I didn’t have to wait long in line—and there were others getting the same vaccines. Sena will get them tomorrow.
It’s up to you.
As of September 25, 2023, 4 free at-home Covid-19 tests are available. See this link for more information.
I was looking at my bookshelves and found the copy of the book, “The Suicidal Crisis: Clinical Guide to the Assessment of Imminent Suicide Risk.” It was written by Dr. Igor Galynker. It’s a fit topic for this month because September is National Suicide Prevention Month.
This brings back memories. I still have a gift from Dr. Galynker. It’s a stuffed animal called Bumpy the Bipolar Bear.
It arrived at my office at The University of Iowa Hospitals & Clinics in 2011. It was in a box addressed to:
WordPress
Attn: James Amos
200 Hawkins Drive
Iowa City, IA 52242
I’m still not entirely sure why he sent me Bumpy. There was no letter of explanation. I was writing a blog at the time called “The Practical Psychosomaticist” and I might have posted something about some research he published on suicide risk assessment.
I bought a copy of his book a few years ago. I barely had time to skim a few of the chapters because I was too busy conducting suicide risk assessments in the emergency room, the general hospital, and the clinics in my role as a psychiatric consultant. In fact, I think it’s an excellent resource.
I also found a YouTube video (posted about a month ago) in which he describes his suicide crisis syndrome assessment. You can find the actual set of questions for the assessment here and in a link posted in the description below the YouTube.
September is National Suicide Prevention Month. The 988lifeline website has many resources for getting the word out about the importance of not missing any opportunities to help prevent suicide.
In fact, there is a recently published article entitled “Multiple Missed Opportunities for Suicide Risk Assessment in Emergency and Primary Care Settings.” A few of the important take home points:
Sena and I were wondering if you need a prescription to get the Respiratory Syncytial Virus (RSV) vaccine.
It turns out only four states require doctor prescription to get RSV vaccine: Iowa, Georgia, Missouri, and Utah. Washington D.C. is working on making the RSV vaccine available without a prescription.
The Iowa Pharmacy Association blog post about the issue makes it clear a prescription is needed to get the RSV vaccine.
Well, as I predicted in an earlier post, I caught Sena’s head cold. I have not had one of these in over 3 years, believe it or not.
It was easy to distinguish my cold from Covid-19, influenza, bubonic plague, and abduction by extraterrestrials. I usually get a dry cough, which causes a headache, a runny nose, mild fatigue and general achiness.
When I’m abducted by extraterrestrials, they usually just want directions to a decent rib joint.
I also had mild nasal congestion, for which I didn’t bother to take phenylephrine. I didn’t take aspirin, or acetaminophen. I didn’t have a fever. I did finally take some cough medicine, which I usually hate. I tend to think the guaifenesin makes me gag, although it’s more likely coughing itself causes that. Raspberry is definitely not my favorite cough syrup flavor.
I took a quick look at the CDC website about colds and found a page on how to distinguish colds from influenza. Colds aren’t that big a deal, but you can get pretty miserable. I don’t know if a summer cold is different from a winter cold. Rhinoviruses cause the common cold and infections tend to cluster in early fall and spring.
The head cold cramped my style. I was too busy sneezing, blowing, and coughing to practice juggling or exercise. It also interfered with sleep.
Interestingly, it didn’t stop me from watching the Men in Black trilogy on TV this week. Funny how that works.
I think we just caught a late summer cold. There was an old Contac commercial about it in the 1970s. I can find the jingle but I can’t find a video of the original commercial.
“A summer cold is a different animal, an ugly animal, ooo…cause it hits you in the summer, when you got a lot to do.”
I don’t have that much to do—but I’d rather not be down with a cold.
One way to think about the Covid-19 pandemic can be that it’s in our rearview mirror, which is one way of saying it’s behind us now.
On the other hand, another way to think about it is that COVID-19 is in our rearview mirror because it’s tailing us.
So, we can’t keep staring in the rearview mirror because that’s not a safe way to drive. We can look forward and drive, paying attention to the signs, which guide us on how to stay ahead of and outrun another pandemic.
One way to do that is to bookmark the CDC COVID-19 web site.
Go Retire Psychiatrist 